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List the differential diagnosis of psychosis (10 possibilities).
Must exclude:
- Psychosis 2' to GMC
- Substance-induced psychotic disorder

Psychotic Disorders:
- Schizophrenia
- Schizophreniform disorder
- Schizoaffective disorder
- Delusional disorder
- Brief Psychotic disorder

Mood disorders:
- Bipolar disorder (I)
- Major depression with psychotic features

Other:
- Delirium / dementia
List the five main mood disorders.
1. Major depressive disorder
2. Bipolar I disorder
3. Bipolar II disorder
4. Dysthymic disorder
5. Cyclothymic disorder

(Some may have psychotic features - delusions or hallucinations)
List the seven main anxiety disorders.
1. Panic disorder
2. Agoraphobia
3. Phobias (specific and social)
4. OCD
5. PTSD
6. Acute stress disorder
7. Generalized anxiety disorder
List the 3 cluster A personality disorders.
- Schizoid
- Schizophreniform
- Paranoid

("MAD")
List the 4 cluster B personality disorders.
- Antisocial
- Borderline
- Histrionic
- Narcissistic

("BAD")
List the 3 cluster C personality disorders.
- Avoidant
- Dependant
- Obsessive-Compulsive

("SAD")
List four depersonalization disorders.
- Dissociative amnesia
- Dissociative fugue
- Dissociative identity disorder (multiple personality disorder)
- Depersonalization disorder
List six somatoform disorders
- Somatization disorder
- Conversion disorder
- Hypochondriasis
- Pain disorder
- Body dysmorphic disorder
- Factitious disorder (includes Munchhausen)
List the components of the mentals status exam. ("ASEPTIC")
A - Appearance and Behaviour
S - Speech
E - Emotion
P - Perception (Hallucination / Illusion)
T - Thought content and process
I - Insight and Judgement
C - Cognition
Name the diagnostic criteria for schizophrenia.
Two or more of the following five symptoms must be present for at least 1 month:

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behaviour
5. Negative symptoms (anhedonia, affect (flat), alogia, avolition, attenton (poor))

- Duration of illness must be at least 6 months.

- Must cause significant social/occupational functional deterioration.
What is the difference between brief psychotic disorder, schizophreniform disorder, and schizophrenia?
Time frame:

Brief psychotic disorder - less than 1 month

Schizophreniform disorder - 1-6 months

Schizophrenia - More than 6 months
What differentiates schizoaffective disorder from mood disorder with psychotic features?
In schizoaffective disorder, there must be a period of at least two weeks where delusions or hallucinations are present in the absence of mood disorder symptoms.
What are the diagnostic criteria for a major depressive episode? ("SIG E CAPS")
At least five symptoms for a period of at least two weeks (depressed mood or anhedonia must be included).

S - Sleep changes (in/hypersomnia)
I - Interest (anhedonia)
G - Guilt

E - Energy (loss, or fatigue)

C - Concentration (lack)
A - Appetite (increased/decreased)
P - Psychomotor activity (restlessness or slowness)
S - Suicidal ideation
What are the diagnostic criteria for a manic episode? ("DIG FAST")
Abnormally and persistently elevated or irritable mood, lasting for at least 1 week and including at least 3 (or 4 if irritable) of:

D - Distractibility
I - Insomnia
G - Grandiosity

F - Flight of ideas
A - Activity (goal-directed) / Agitation
S - Speech (increased / pressured)
T - Thoughtlessness (high-risk activities)

(75% of manic patients have psychotic symptoms)
List four features that differentiate hypomania from mania.
- No psychotic features
- Lasts at least 4 days (vs. 7)
- No marked impairment in social/occupational function
- Does not require hospitalization
List the diagnostic criteria for dysthymic disorder. ("2 Ds; CHASES")
- 2 years of mild depression

- Never more than 2 months without symptoms

- 2 of the following:

C - Concentration impairment
H - Hopelessness
A - Appetite changes
S - Insomnia/hypersomnia
E - Fatigue/lack of energy
S - Diminished self-esteem

Dysthymia can never have psychotic features.
List the diagnostic criteria for a panick attack. ("PANIC")
Discrete period of intense fear and discomfort accompanied by at least four of:

P - Palpitations
A - Abdominal distress
N - Numbness, nausea
I - Intense fear of dying or losing control
C - Choking, chills, chest pain

(Also: sweating, shaking, shortness of breath, light-headedness, depersonalization)
What disorder must also be assessed when diagnosing panic disorder?
Agoraphobia

(50-75% of patients have coexisting panic disorder)
The rate of OCD is higher in patients who have first-degree relatives with which mental disorder?
Tourette's disorder.
What are the four most common mental disorders?
1. Phobias
2. Substance-induced disorders
3. Major depression
4. OCD
List two features of acute stress disorder that differentiate it from post-traumatic stress disorder.
1. Event occurred less than 1 month ago.

2. Symptoms last less than one month.
What is characteristic about the anxiety in generalized anxiety disorder?
Anxiety is free-floating - not associated with a specific event, person, or situation.

(Must be present for at least 6 months.)
What are the time constraints listed in the diagnostic criteria for adjustment disorder?
- Emotional or behavioural symptoms must develop within 3 months after a stressful, non life-threatening event.

- Symptoms resolve within 6 months after stressor has terminated.

(Also, symptoms are not those of bereavement.)

List the diagnostic criteria for borderline personality disorder. ("IMPULSIVE")
At least five of the following:

I - Impulsivity (harmful - spending, sex, drugs)
M - Moody (unstable)
P - Paranoid under stress
U - Unstable self-image
L - Labile, intense relationships
S - Suicidal (recurrent threats/attempts)
I - Inappropriate anger
V - Vulnerable to abandonment
E - Emptiness (general feeling of)
What feature differentiates schizoid from avoidant personality disorder?
Schizoid patients prefer to be alone. Avoidant patients want to be with others, but are too scared of rejection.
Personality disorders manifest as impairments in which four domains? ("CAPRI")
Two of the following:

C - Cognition
A - Affect
PR - Personal Relations
I - Impulse Control

Also, pattern is inflexible, pervasive and stable. Must have had an onset no later than adolescence or early adulthood.
List the symptoms and treatment of delirium tremens.
Delirium, hallucinations, gross tremor, autonomic instability, fluctuating psychomotor activity.

Tx: Benzodiazepines, MgSO4 (seiz)

- 5% of patients hospitalized for EtOH withdrawal
- 15-20% mortality if untreated
Rotatory nystagmus is pathognomonic for intoxication with what drug?
Phencyclidine (PCP)
List six symptoms of inattention and five symptoms of hyperactivity-impulsivity.
Inattention:
- Problems listening
- Problems concentrating
- Problems paying attention
- Problems organizing tasks
- Easily distracted
- Often forgetful

Hyperactivity-impulsivity:
- Blurting out
- Interrupting
- Fidgeting
- Leaving seat
- Talking excessively
Children with autism have impairments in which three domains?
Social interaction
Communication
Repetitive and stereotyped movements.
What differentiates Asperger's disorder from autism?
Patients with Asperger's disorder have normal language and cognitive development.
Tourette's disorder is associated with impaired regulation of what neurotransmitter?
Dopamine

(Tx: neuroleptics)
What are the diagnositc criteria for somatization disorder?
- At least two GI complaints
- At least sexual/reproductive symptom
- At least one neurological symptom
- At least four pain symptoms
- Onset before 30
- Cannot be explained by GMC / substance use

("Somatization - so many complaints")
La belle indifference is characteristic of what somatoform disorder?
Conversion disorder.

(Pts often appear calm and unconcerned about their symptom(s))
What differentiates somatization disorder from hypochondriasis?
Hypochondriacs are worried about disease, whereas patients with somatization disorder are concerned about their symptoms.
What differentiates factitious disorder / Munchhayusen syndrome from malingering?
Factitious disorder: patients pretend they are ill with no obvious external reward.

Malingering: patients pretend they are ill with an obvious external incentive.
Low levels of which neurotransmitter have been shown to be associated with impulsiveness and agression?
Serotonin.
List five impulse control disorders.
Intermittent explosive disorder.
Kleptomania
Pyromania
Pathological gambling
Trichotillomania
List the four diagnostic criteria for anorexia nervosa.
- Body weight at least 15% below normal (= primary distinguishing feature between AN and bulimia)
- Intense fear of gaining weight
- Disturbed body image
- Amenorrhea
What is the difference between excessive daytime sleepiness and fatigue?
EDS - falling asleep when you don't want to (e.g. driving car)

Fatigue - lacking energy to accomplish desired tasks
What are the clinical characteristics of serotonin syndrome?
Confusion
Flushing
Diaphoresis
Tremor
Myoclonic Jerks

Can progress to hyperthermia, hypertonicity, rhabdomyolysis, renal failure, convulsions, coma, death.
What are the clinical characteristics of neuroleptic malignant syndrome? ("FALTER")
F - Fever
A - Autonomic instability
L - Leukocytosis
T - Tremor
E - Elevated CPK
R - Rigidity
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